Provider Demographics
NPI:1841855004
Name:BAESEL, PAUL GEROGE-EDGAR
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:GEROGE-EDGAR
Last Name:BAESEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10545 PARK MEADOWS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-228-8958
Mailing Address - Fax:
Practice Address - Street 1:10545 PARK MEADOWS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-228-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019843101YM0800X
171M00000X, 320800000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness